People with diabetes could benefit from digital ‘risk calculators’ that help professionals prescribe the best combination of medicine.

Scientists develop calculators to help clinicians decide on best diabetes treatments

People with diabetes could benefit from digital ‘risk calculators’ in the future that help healthcare professionals prescribe the best combination of medicine for each person. The research into personalised treatments, which can improve people's long-term health, was presented at the Diabetes UK Professional Conference.

The charity says more needs to be done to tackle the diabetes crisis in the UK, including investing more in research and improving healthcare and treatment of all types of diabetes.

One risk calculator developed by a team across Exeter, Dundee, Oxford and Glasgow Universities, predicts how well someone’s blood glucose levels will be controlled by two drugs used to treat Type 2 diabetes. Sulfonylureas and thiazolidinedione are second-line treatments for Type 2 diabetes, but there is currently little guidance about which therapies work best and for who.

The research team at Exeter is also working on a risk calculator that could be used to help people get the right diagnosis of Type 1 or Type 2 diabetes. Unfortunately, it can sometimes be difficult to classify the type accurately, resulting in delays to treatment or in some cases the wrong treatment. It’s important that people are diagnosed with the correct type of diabetes, as people with Type 1 diabetes need insulin therapy as early as possible, while people with Type 2 diabetes are best treated with medications or diet and exercise.

Both risk calculators will help doctors prescribe the best possible treatment, as different people respond to treatments in different ways. This should also help to improve people’s health outcomes, as tailored diagnosis and treatments should mean the right therapy is given to the right person sooner, based on more accurate predictions of how someone will respond.

To predict blood glucose control, the researchers used data from more than 70,000 people with Type 2 diabetes in clinics together with 2,000 people in clinical trials who were taking either sulfonylureas or thiazolidinedione. They examined how their blood glucose levels were influenced by simple characteristics including gender, age and Body Mass Index (BMI).

Using this information, they created a risk calculator that predicts how well a person’s blood glucose levels will be controlled by each drug. Extending the calculator to include other medication could help clinicians to develop a personalised treatment regime for their Type 2 diabetes patients.

The Exeter research team’s Type 1 diabetes classification calculator uses clinical information (like age of diagnosis or BMI) together with indicators of Type 1 diabetes (like levels of autoantibodies and a new genetic test of Type 1 diabetes risk) to accurately predict the type of diabetes. This helps to decide if a person should receive insulin or tablets at diagnosis. The calculator has been developed using information from 1187 people who have taken part in previous studies.

Dr Angus Jones, lead researcher based at the University of Exeter Medical School, said: “An accurate diagnosis of Type 1 or Type 2 diabetes is hugely important, as the treatment of these two conditions is very different. Unfortunately it can be difficult to tell what type of diabetes someone has when they’re first diagnosed, as there’s no single feature that confirms a diabetes type. By using a simple website programme or smartphone app called a clinical calculator, we can combine different features to give an accurate probability of whether a person has Type 1 or Type 2 diabetes. This will help doctors and patients to decide on the best initial treatment and whether extra tests are needed.

We are currently testing this calculator in a large study of 1500 people newly diagnosed with diabetes, funded by the National Institute of Health Research. We hope research like this will help people with diabetes answer two important questions: what type of diabetes do I have and what treatment works best for me?”

This research comes in the wake of a similar approach for Maturity Onset Diabetes of the Young (MODY): a rare form of diabetes that affects 1-2 percent of people with diabetes. Dr Beverley Shields, a statistician within the Exeter research team, has developed a calculator to help identify people with MODY to ensure they receive the right diagnosis and the right treatment. This is now available online and as part of the Diabetes Diagnostics app. This calculator is now used prior to virtually all referrals for MODY genetic testing. It’s anticipated that both new calculators highlighted here will be added to the website and app in the near future.

Dr Elizabeth Robertson, Director of Research at Diabetes UK, said: “Diabetes is an incredibly complex condition and people respond to different therapies in different ways. What works for one person may not work for another. We need to move away from a ‘one size fits all’ approach to both treatments and diagnosis.

“Research like this is helping us to manage that complexity and move towards a more personalised approach to caring for people with different types of diabetes. People with diabetes face the risk of life-changing, and life-limiting, complications, unless they are given the very best care and the support they need to manage their condition well alongside the right treatment at the point of diagnosis.”

For every £1 spent on diabetes care, only 0.5p is spent on research. Around £60 million is spent on diabetes research in the UK, compared to £500 million on cancer research. This is holding back progress on better care and treatment or finding a cure.

The Diabetes UK Professional Conference 2017 is being held 8-10 March at Manchester Central Convention Complex, Manchester. The world-class conference is run exclusively for healthcare professionals and scientists working in the field of diabetes and is one of the largest healthcare conferences in the UK.